Platinum-pemetrexed following first-line nivolumab and ipilimumab in pleural mesothelioma: real-world outcomes

First-line nivolumab plus ipilimumab is the standard first-line treatment for pleural mesothelioma (PM). There is no approved second-line treatment for PM. In the real-world MesoNet cohort, at twelve centers in Germany, real-world outcomes with second-line platinum-pemetrexed were investigated. Among 135 patients treated with first-line nivolumab-ipilimumab, 57 (42%) received second-line treatment, of whom 41 (72%) received platinum-pemetrexed. The median overall survival and median progression-free survival from start of the second-line treatment were 11.5 months (95% CI 8.6-13.8) and 5.8 months (4.1-7.0), respectively. The disease control rate was 72%, with partial response in 28% of patients. Only 22 patients (16% of the first-line cohort) received third-line treatment, indicating substantial treatment attrition. The authors conclude that second-line platinum-pemetrexed after first-line nivolumab-ipilimumab demonstrated meaningful clinical activity.